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Category: Penis Health

Nitroglycerin Gel for ED: Pros, Cons, & Practical Information

About Nitroglycerin Gel for Erectile Dysfunction

Medically reviewed by Matt Coward, MD, FACS — Written by Sara Lindberg on December 16, 2020

This article is a repost which originally appeared on Healthline

Edited for content

Erectile dysfunction (ED) may affect as many as 30 million men in the United States. People with ED experience an inability to get or keep an erection firm enough for sex.

You may be familiar with some of the more common treatments for ED, including lifestyle modifications, oral medications that include phosphodiesterase type 5 inhibitors (PED5 inhibitors), and penis pumps.

But a study published in the Journal of Sexual Medicine also looked at the use of nitroglycerin gel or cream as a topical treatment for ED. Although results look promising, it’s important to note that nitroglycerin gel or cream isn’t approved by the Food and Drug Administration (FDA) to treat ED.

Here’s what you need to know about nitroglycerin as a topical treatment for erectile dysfunction.

What is nitroglycerin?

Nitroglycerin is part of a class called vasodilators, which widen the blood vessels and improve blood flow to allow oxygen-rich blood to reach the heart.

It comes in a variety of forms, including sublingual (under-the-tongue), topical cream or gel, and as a transdermal patch. Nitroglycerin is most often used to prevent angina or attacks of chest pains.

Nitroglycerin for ED

“The idea of treating ED with topical nitroglycerin is not new and was first described in the 1980s,” says Dr. Joseph Brito, a urologist at Yale New Haven Health, Lawrence + Memorial Hospital. Brito is also a member of Healthline’s clinical review network.

In general, Brito says nitroglycerin works by dilating the blood vessels, which is why it’s traditionally used for patients with angina or chest pain due to poor cardiac vessel blood flow.

The concept is the same for ED, although Brito says it may have a dual mechanism of action:

  • It widens blood vessels helps blood flow.
  • It relaxes penile smooth muscle, which in turn compresses penile veins and impedes blood flow out of the penis, which causes rigidity.

How does nitroglycerin gel work?

According to Brito, nitroglycerin gel or cream differs from other ED treatments such as oral medications:

“[Topical nitroglycerin] acts as a nitrogen donor to increase local levels of nitric oxide, which works through molecular signaling (cGMP pathway) to cause this response,” he says.

On the other hand, Brito says PDE5 inhibitors (like tadalafil and sildenafil) work at a later step in the chain by inhibiting the breakdown of cGMP.

Nitroglycerin for ED doesn’t have enough research

That said, Brito points out that nitroglycerin gel or cream is currently not approved by the FDA to treat ED.

Moreover, Brito points out that the American Urological Association guideline on erectile dysfunction published in 2018 didn’t include topical nitroglycerin as a suggested treatment for men with ED.

“Though this therapy was not specifically mentioned, the authors did state ‘the use of these treatments may preclude the use of other treatments known to be effective,’ and felt more research was needed,” he explains.

And there’s another factor to consider: Nitroglycerin cream on the outside of the penis might be transferred to your partner.

Why are people interested nitroglycerin gel for ED?

“Nitroglycerin may have some benefits over standard oral ED medications,” Brito says.

The onset of topical nitroglycerin is between 10 and 20 minutes, which Brito says is better than the quickest acting oral agents, with sildenafil taking at least 30 minutes.

In fact, the 2018 study published in the Journal of Sexual Medicine found that 44 percent of patients saw erection beginning within 5 minutes of application. Seventy percent of the men noticed an erection within 10 minutes.

The randomized, double-blind, placebo-controlled study included 232 men with ED who participated in two 4-week trials. One trial used a 0.2 percent glyceryl trinitrate topical gel before sex, and the other used a placebo gel.

“This may help with spontaneity, which can be an issue for couples using oral agents,” Brito explains.

Another benefit, Brito says, is that unlike other ED treatments like oral agents, nitroglycerin doesn’t need to pass through the gastrointestinal (GI) tract.

“Since absorption of oral agents like sildenafil is strongly affected by food intake, the medications are much more effective when taken on an empty stomach,” he says. This requires more planning and doesn’t always allow for spontaneity.

Where to buy nitroglycerin for ED

Nitroglycerin gel or cream is currently not approved by the FDA to treat ED.

If you have questions about this topical treatment, you need to talk with a doctor who knows your medical history. A prescription is needed for nitroglycerin.

How to take nitroglycerin gel for ED

Nitroglycerin use is managed by your doctor. Don’t use or apply this topical treatment without guidance.

According to the Journal of Sexual Medicine, the concentration studied was 0.2 percent, which Brito says likely explains why the effect was best for men with mild ED.

He also points out that other studies used concentrations of 0.2 to 0.8 percent for patients with more severe ED, who likely needing higher concentrations.

In general, Brito says people prescribed nitroglycerin by their doctor should apply a small amount (pea-sized) to the head of the penis.

Side effects and contraindications

Nitroglycerin is certainly not for everyone. According to a 2018 review, taking nitroglycerin-based medications with certain PDE5 inhibitors like Viagra is contraindicated. Using them together can result in a sudden and serious decrease in blood pressure and potentially death.

According to Brito, some drawbacks of topical nitroglycerin include possible transmission to the partner, which can lead to the partner sharing in side effects, especially low blood pressure. This can lead to headache and nasal congestion.

Other treatments for ED

There are several treatments available for ED, including:

  • oral medications that include PDE5 inhibitors such as sildenafil (Viagra) and tadalafil (Cialis). Other oral medications include vardenafil HCL (Levitra), and avanafil (Stendra)
  • erectile dysfunction pump (penis or vacuum pump)
  • penile injections
  • inflatable penile prosthesis
  • psychotherapy (talk therapy) for emotional or psychological issues related to ED
  • suppositories (Alprostadil)
  • counseling
  • diet modifications
  • exercise
  • stress reduction

The takeaway

Although some research points to the effectiveness of nitroglycerin gel or cream for improving the symptoms of ED, it’s currently not approved by the FDA as a treatment for erectile dysfunction.

If you have ED or think you may have ED, it’s important that you talk with a doctor about any treatment options. They can talk with you about the range of options, including lifestyle modifications, counseling, oral agents, penis pumps, surgery, and implants.

Premature Ejaculation

Premature Ejaculation

What Is It?

Published: February, 2020

This article is a repost which originally appeared on Harvard Health

Edited for content

Premature ejaculation occurs when a man reaches orgasm and ejaculates too quickly and without control. In other words, ejaculation occurs before a man wants it to happen. It may occur before or after beginning foreplay or intercourse. Some men experience a lot of personal distress because of this condition.

As many as one in five men experience difficulty with uncontrolled or early ejaculation at some point in life. When premature ejaculation happens so frequently that it interferes with the sexual pleasure of a man or his partner, it becomes a medical problem.

Several factors may contribute to premature ejaculation. Psychological problems such as stress, depression and other factors that affect mental and emotional health can aggravate this condition. However, there is growing evidence that biological factors can make some men more prone to experience premature ejaculation.

Rarely, premature ejaculation can be caused by a specific physical problem, such as inflammation of the prostate gland or a spinal cord problem.

Symptoms

The key symptoms of premature ejaculation include:

  • Ejaculation that routinely occurs with little sexual stimulation and with little control
  • Decreased sexual pleasure because of poor control over ejaculation
  • Feelings of guilt, embarrassment or frustration

Diagnosis

Premature ejaculation is diagnosed based on typical symptoms. To understand your problem, your doctor will need to discuss your sexual history with you. Be frank and open. The more your doctor knows, the better he or she can help you.

If your sexual history fails to reveal significant mental or emotional factors that may contribute to premature ejaculation, your doctor may want to examine you. Your doctor may examine your prostate or do neurological tests (tests of your nervous system) to determine if there is a physical problem that could be causing premature ejaculation.

Expected Duration

Sometimes, premature ejaculation goes away on its own over weeks or months. Working to relieve stress or other psychological issues may help the situation to improve.

Other men have lasting difficulties with premature ejaculation, and require professional help. Some men respond to treatment promptly, while others struggle with this problem over a prolonged period. Effective treatment is available.

Prevention

There is no known way to prevent premature ejaculation. However, you should consider the following advice:

  • Maintain a healthy attitude toward sex. If you experience feelings of anxiety, guilt or frustration about your sex life, consider seeking psychotherapy or sexual therapy.
  • Keep in mind that anyone can experience sexual problems. If you experience premature ejaculation, try not to blame yourself or feel inadequate. Try speaking openly with your partner to avoid miscommunication.

Treatment

Behavioral therapy is one possible approach for treating premature ejaculation. Most commonly, the “squeeze technique” is used. If a man senses that he is about to experience premature orgasm, he interrupts sexual relations. Then the man or his partner squeezes the shaft of his penis between a thumb and two fingers. The man or his partner applies light pressure just below the head of the penis for about 20 seconds, lets go, and then sexual relations can be resumed. The technique can be repeated as often as necessary. When this technique is successful, it enables the man to learn to delay ejaculation with the squeeze, and eventually, to gain control over ejaculation without the squeeze. Behavioral therapy helps 60% to 90% of men with premature ejaculation. However, it requires the cooperation of both partners. Also, premature ejaculation often returns, and additional behavioral therapy may be needed.

Another possible treatment is prescription medication that helps to delay ejaculation. Delayed orgasm is a common side effect of certain drugs, particularly those used to treat depression. This is true even for men who are not depressed. When this type of medication is given to men who experience premature ejaculation, it can help to postpone orgasm for up to several minutes. Drugs used for this type of treatment include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft); and tricyclic antidepressants, such as clomipramine (Anafranil).

Some men with premature ejaculation may benefit from drugs called phosphodiesterase inhibitors, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). A phosphodiesterase inhibitor can be used alone or in combination with an SSRI. One drug should be started at a time, preferably at a low dose.

Some men with premature ejaculation also benefit from reducing the stimulation they experience during sex. A number of creams are available that can partially anesthetize (numb) the penis and reduce the stimulation that leads to orgasm. Another option is to use one or more condoms. However, these techniques may interfere with the pleasure experienced during sex.

When To Call a Professional

Speak with your doctor if you consistently ejaculate before you want to. Remember, one instance of premature ejaculation does not mean that you have a condition that requires treatment. Your doctor may refer you to a sex therapist if premature ejaculation is causing major problems in your sex life or personal relationships or if you would like to consider behavioral therapy.

Prognosis

Many men experience a brief period of premature ejaculation, then improve on their own. Even for men who require medical treatment, the outlook is usually good.

Types of penises: Shape, size, circumcision, and more

What to know about types of penises

Medically reviewed by Joseph Brito III, MD — Written by Mathieu Rees on November 23, 2020

This article is a repost which originally appeared on MEDICAL NEWS TODAY

Edited for content

The penis is a male organ with functions that include reproduction and urination. As with any body part, no two people have the same penis.

The penis has two main features. The body, or shaft, connects the penis to the abdomen. At the opposite end of the shaft is the glans, or head.

This article lists some common types of penises, categorized primarily by measurement, and provides some related information.

Length

Penises come in different lengths when flaccid or erect.

Estimates about average penis length can vary. For example, one 2014 study looked at the penis size of United States males. It found that the average erect length was around 5.6 inches.

However, another article suggests there are issues with many penis length studies, including the fact that participants self-report measurements.

These studies use self-reported data and are therefore subject to bias, which likely fuels the widespread belief that the average penis size is closer to 6 inches. In reality, the average is likely to be lower

Girth

Penises also have different girths or circumferences.

A 2014 study into the penis size of U.S. males found that the average erect girth was around 4.8 inches.

However, as with penis length, a person should note that many penis girth studies use self-reported measurements, which are known to be fairly unreliable.

Curvature

Some penises are completely straight when erect. However, many have a bend or curvature. There are three main types of curved penis. These include penises that:

  • curve upwards from its base
  • curve downwards from its base
  • curve to the left or right

Additionally, some people may have multiple kinds of curvature. For instance, some penises may curve to the left and upwards.

Penile curvatures are common and typically benign. They are rarely painful and do not usually make penetrative sex more difficult.

However, abnormal penile curvature can sometimes be a symptom of Peyronie’s disease. One review lists the following as possible symptoms:

  • a thickened area, or plaque, in the penile shaft
  • curvature of the penis during erection
  • pain in the penis
  • erectile dysfunction

Scientists are not sure what causes Peyronie’s disease.

One common explanation is that the condition results from mild, recurring trauma to the penis. This can occur during intercourse or masturbation.

Peyronie’s disease can also be due to a rupture in the penis, known as a penile fracture. Genetic factors may also contribute to the development of this condition.

Anybody who suspects they may have Peyronie’s disease should seek medical advice. Sometimes, people with the condition who experience no other issues, such as pain, could still use their penis for sexual activity without needing medical treatment.

In some cases, doctors may recommend surgery to remove the plaque or reduce the curvature in the penis.

The base to head ratio

For some people, the circumference of the base of their penile shaft is the same as the circumference of their penile head.

For others, this ratio is different. Some may have a penile head with more girth than the base of their shaft, or vice versa.

Circumcised and uncircumcised

A person with a penis is born with a retractable layer of skin that covers the penile head, commonly referred to as the foreskin.

Many people around the world have their foreskin surgically removed, in a process known as male circumcision.

A trained person may carry out male circumcision on children and adults, often for cultural or religious reasons. Doctors can also perform them in medical treatments.

Circumcised penises do not have a foreskin, which means that the glans is always visible. Uncircumcised penises have a foreskin, which often covers the glans, especially when the penis is flaccid.

Some infants can be born without a foreskin, which is a condition called hypospadias. Here, the opening of the penis is not found at the tip. Surgery is usually required to correct this issue.

Uncircumcised men can also develop phimosis, where the foreskin cannot retract over the hood of the glans. This can lead to irritation and infection. People with the condition generally require medical circumcision.

Because circumcision is a surgical process, it can sometimes lead to health issues, including:

  • infection
  • necrosis of the penile head
  • cut to the penile head or urethra
  • penile loss

However, people should note that this procedure is very common. Infections following circumcision, one of the most common possible complications, affect just 0.5% of people.

Summary

Many internet sources misinform and perpetuate myths about penises. In reality, they are highly varied, just like other body parts.

Anyone who has concerns about their penis can seek medical advice from a trained professional.

Men’s Health Month – Testicular health

Men’s Health Month – Testicular health

Leigh Day

This article is a repost which originally appeared on LEXOLOGY

Edited for content

United Kingdom November 23 2020

We have reached the end of Men’s Health Awareness Month and we are now heading towards our first Coronavirus Christmas. My November has been spent in lockdown, glued to the US election whilst growing a tashe for Movember, a month-long charity event set up to highlight and fundraise for men’s health causes that include mental health, suicide prevention, prostate cancer and testicular cancer.

Did you know that in the UK, men visit their GP on average half as many times as women? On top of this worrying statistic is the fact that we are currently stuck in a global pandemic that has no end in sight. In April 2020, NHS England found that four out of 10 people were not seeking help from their GP because they were afraid of being a burden during a pandemic.

Being a burden should never be a consideration for not visiting your GP if you are worried about your health, regardless of how big or small you perceive the problem to be. The sooner a problem is shared, the quicker it can be solved.

One area that is important for men not to ignore is testicular health. Testicles are responsible for the production of sperm and also testosterone so it is vital we look after them.

Problems with your testicles can start when you develop a lump or a swelling. Whilst both these are not usually caused by anything serious, you should always speak with a doctor and get them checked.

The longer a problem with your testicles is left untreated, the worse it can get. With some testicular problems, time is very much of the essence and if you don’t act fast, there can be serious consequences.

In my role as a healthcare solicitor at Leigh Day, I have come across three different types of testicular problems where early discovery and diagnosis is vital to having the best long-term outcome. It is important that we all know the early signs of these problems, so that we seek GP advice if we are worried.

Testicular Cancer

Testicular cancer is where a tumour forms on or inside one of the testicles. Typical symptoms of testicular cancer include:

  • A painless swelling or lump in one of the testicles,
  • A change in shape, texture, firmness or appearance of a testicle,
  • A dull intermittent ache or pain or the feeling of heaviness in the scrotum.

Testicular cancer is the most commonly diagnosed cancer of men between the ages of 15 and 49 years old in the UK. It is also one of the most treatable types of cancer and it has a survival rate of above 95 per cent. However, if undiagnosed, the cancer can spread further than your testicles and become far more complicated to treat.

Testicular Torsion

Testicular torsion is when the testicle twists around the spermatic cord. When this happens, it cuts off the blood flow to the testicle. Symptoms of a testicular torsion include:

  • A sudden, severe pain on one side of the scrotum,
  • Swelling of the scrotum,
  • Abdominal pain,
  • Nausea and vomiting,
  • A testicle that’s positioned higher than normal or at an unusual angle,
  • Frequent urination,
  • Fever

A testicular torsion can happen at any time – during exercise, sitting, standing or even sleeping. It is a medical emergency and should be treated within four to six hours of the onset of pain. If the blood supply is not restored quickly, it will cause the testicle to shrink and die.

Testicular Infection

Epididymitis is a testicular infection where the tube at the back of the testicle becomes painful and swollen. Symptoms of epididymitis include:

  • A sudden or gradual pain in one or both testicles,
  • The scrotum feeling warm, tender and swollen,
  • A build-up of fluid around the testicle that feels like a lump or swelling

Whilst epididymitis can be treated easily with antibiotics, if it is ignored it can spread to the testicle and can lead to chronic testicular pain, the growth of an abscess, infertility and the loss of your testicle.

Examining yourself

It is important to examine your testicles once a month to check for any changes, swellings or lumps. The best time to do this is after you have taken a bath or shower by resting your testicles in the palm of your hand, and gently rolling each one between a finger and your thumb. For further information on examining yourself, please visit the Movember “guide to checking your nuts”.

If you find something strange, are experiencing swelling or sudden and unexplained pain in one or both of your testicles, don’t stew over whether it’s serious or not – get checked out by a doctor. The earlier a problem is diagnosed, the better the chance of successful treatment will be.

Conclusion

I understand that for some men, the idea of sitting and talking with a doctor about your testicles can be embarrassing, worrying or stressful. I also appreciate that whilst we are in a middle of a global pandemic, people want to avoid visiting the doctor. However, if there is a problem or you are worried about your testicles, go see a doctor and tell them what is worrying you.

The earlier the problem is diagnosed, the sooner treatment can be given and the better your chances will be of a full recovery will be.

10 Natural Ways to Boost Your Libido

Boost Your Libido with These 10 Natural Tips

Medically reviewed by University of Illinois — Written by Alexia Severson — Updated on May 11, 2019

This article is a repost which originally appeared on Healthline

Edited for content

The natural approach

Looking to spice up your sex life? There are a variety of things you can do in your everyday life that can help boost your libido and enhance your sex life.

1. Try eating certain fruits

Little evidence supports the effectiveness of certain foods, but there’s no harm in experimenting.

Figs, bananas, and avocados, for example, are considered libido-boosting foods, known as aphrodisiacs.

But these foods also provide important vitamins and minerals that can increase blood flow to the genitals and promote a healthy sex life.

2. Try eating chocolate

Throughout history, chocolate has been a symbol of desire. Not just because of its delicious taste, but because of its power to improve sexual pleasure.

According to one study, chocolate promotes the release of phenylethylamine and serotonin into your body. This can produce some aphrodisiac and mood-lifting effects.

According to another study, the effects of chocolate on sexuality are probably more psychological than biological.

3. Take your daily herbs

Next time you decide to sit down for a romantic dinner, add a little basil or garlic to your dish. The smell of basil stimulates the senses. Garlic contains high levels of allicin, and increases blood flow.

These effects may help men with erectile dysfunction.

Ginkgo bilobaTrusted Source, an extract derived from the leaf of the Chinese ginkgo tree, is another herb found to treat antidepressant-induced sexual dysfunction.

4. Take a tip from Africa

Yohimbine, an alkaloid found in the bark of the West African evergreen, has been known to work as a natural Viagra.

Some studies suggest that Yohimbine bark can help you maintain an erection. It will also enhance the quality of an erection. However, researchers say there is no natural equivalent to match Viagra.

5. Boost your self-confidence

The way you feel about your body affects the way you feel about sex. An unhealthy diet and lack of exercise may cause you to have a poor self-image. These things can discourage you from having and enjoying sex.

You can boost your self-esteem and your sex drive by shifting the focus from your flaws to your attributes. You can also focus on the pleasure experienced during sex.

6. Stick to one glass of wine

Two glasses of wine might be one too many. Drinking one glass of wine can put you at ease and increase your interest in becoming intimate. But too much alcohol can ruin your ability to perform by affecting erectile function. Too much alcohol can also inhibit your ability to orgasm.

7. Take time to meditate and relieve stress

No matter how healthy you are, being stressed out is going to affect your sex drive. Women are particularly susceptible to the effects stress can have on one’s sex life.

Men, on the other hand, sometimes use sex to relieve stress. And sometimes differences in the approach to sex may cause conflict.

To relieve stress, participate in sports activities, practice tai chi, or take a yoga class.

8. Get plenty of sleep

Those with a hectic lifestyle don’t always have the time to get the right amount of sleep. Being busy also makes it difficult to make time for sex.

People who balance work with caring for aging parents or young children are often left exhausted, which can lead to a reduced sex drive.

Boost your energy and sex drive by taking naps when you can and eating a healthy diet high in protein and low in carbohydrates.

9. Keep your relationship in check

After you’ve had an argument with your partner, chances are you’re not in the mood to have sex. For women, sensing emotional closeness is important to sexual intimacy. That means unresolved conflicts can affect your sexual relationship.

Communication is essential for building trust. It’s important to prevent resentments from building up.

Consult a doctor

Even if you’re taking a natural approach to boosting your sex drive, it still might be a good idea to talk with your doctor. They can help you identify underlying problems.

Your doctor may suggest some strategies for enhancing sexual health.

These may include communicating with your partner, making healthy lifestyle choices, and treating underlying medical conditions. Knowing the root of the problem affecting your sex life will make it easier to find a solution.

10. Trial and error

There are a variety of different approaches that may enhance your sex drive naturally. However, it’s important to remember that every couple is different. It may take a little experimentation to find out what works best for you.

If you do decide to turn to prescription drugs, remember that desire is at the core of sex. It’s important to remember that a little blue pill may not be the answer if emotional issues are affecting your libido.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

J Endocrinol Invest. 2020 Jul 13 : 1–9.
doi: 10.1007/s40618-020-01350-1 [Epub ahead of print]
PMCID: PMC7355084
PMID: 32661947

A. Sansone,1 D. Mollaioli,1 G. Ciocca,2 E. Limoncin,1 E. Colonnello,1 W. Vena,3,4 and E. A. Janninicorresponding author1

This abstract is a repost which originally appeared on PMC-NCBI

Edited for content

Abstract

Purpose

The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a “cytokine storm”, which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients.

Methods

A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed.

Results

Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED.

Conclusion

COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.

Keywords: COVID-19, SARS-CoV-2, Erectile dysfunction, Sexual dysfunction, Male hypogonadism, Cardiovascular health

Introduction

The global outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents an unprecedented challenge for healthcare. Despite social distancing and isolation measures, the number of affected patients is growing daily. Hyperinflammation and immunosuppression are prominently featured in COVID-19 [, ], resulting in a cytokine storm [] ultimately leading to development of micro-thrombosis and disseminated intravascular coagulation (DIC). This cytokine storm is strongly associated with the development of interstitial pneumonia (IP) []; however, although lungs are the primarily targeted organs, the cardiovascular system is globally affected. Evidence in this regard supports the notion that the exaggerated production of early response proinflammatory cytokines, such as tumor necrosis factor (TNF), interleukin-1β, -6, and -10 (IL-1β, IL-6, and IL-10, respectively), increases the risk of vascular hyperpermeability, possibly progressing to multiple organ failure and, ultimately, death []. The presence of vascular dysfunction at multiple levels, including pulmonary embolisms, alveolar hemorrhage, microangiopathy and vasculitis has been ascertained in post-mortem examination [, ]. Additionally, both venous and arterial thromboembolic complications, including endothelial inflammation, have been reported [, ]. Indeed, a growing body of evidence seems to support the theory that the endothelium is targeted by the SARS-CoV-2 []; most importantly, the endothelium expresses the protein angiotensin-converting enzyme 2 (ACE2) [, ], through which the virus can access host cells []. Endothelial dysfunction is, therefore, a pivotal determinant of COVID-19 symptoms [, ].

As of June 12th, 2020, more than 7.5 million COVID-19 cases have been confirmed worldwide, with more than 420,000 lives lost due to the disease []. More than 3.5 million subjects have recovered from COVID-19; however, the long-term consequences of the disease are still largely unknown. Data from 2002–2004 epidemics of SARS suggest that cardiovascular sequelae, such as microangiopathy, cardiomyopathy and impaired endothelial function, are to be expected also in COVID-19 patients [, ]. However, while similarities with SARS have been identified, COVID-19 is largely more prevalent due to its high transmissibility, and its consequences, even for recovered patients, are likewise more worrying. Additionally, new evidence is suggesting that autoimmune conditions, such as type 1 diabetes mellitus, might be triggered by the onset of COVID-19 [], therefore, worsening the risk profile for survivors.

These findings can be extremely relevant for male sexual health: indeed, based on these premises, there is quite enough evidence to hypothesize that consequences of COVID-19 can extend to sexual and reproductive health. We investigated the current literature to understand the long-term clinical complications for COVID-19 survivors, aiming to provide adequate information for clinicians to plan adequate and timely intervention measures.

Testosterone and COVID-19: friend or foe?

It is well established that ACE2 is the entry point for the SARS-CoV-2 in host cells []. In males, adult Leydig cells express this enzyme, therefore, suggesting that testicular damage can occur following infection []. Testicular damage in COVID-19 might, therefore, induce a state of hypogonadism as proven by decreased testosterone-to-LH ratio in patients with COVID-19, suggestive of impaired steroidogenesis resulting from subclinical testicular dysfunction [, ]. Post-mortem examinations of testicular tissue from 12 COVID-19 patients showed significantly reduced Leydig cells, as well as edema and inflammation in the interstitium []. A recent report on 31 male COVID-19 patients in Italy identified that some patients developed hypergonadotropic hypogonadism following the onset of the disease []. In the same study, lower levels of serum testosterone (total and free) acted as predictors of poor prognosis in SARS-CoV-2 men []. Whether this state of hypogonadism is permanent or temporary is a question so far left unanswered. Testosterone acts as a modulator for endothelial function [] and suppresses inflammation by increasing levels of anti-inflammatory cytokines (such as IL-10) and reducing levels of pro-inflammatory cytokines such as TNF-α, IL-6 and IL-1β []. It can, therefore, be hypothesized that suppression of testosterone levels might be one of the reasons for the large difference in terms of mortality and hospitalization rate between males and females and might also explain why SARS-CoV-2 most commonly infects old men.

On the other hand, androgens seem to play a pivotal role in COVID-19 by promoting the transcription of the transmembrane protease, serine 2 (TMPRSS2) gene. The encoded protein primes the spike protein of SARS-CoV-2, therefore, impairing antibody response and facilitating the fusion between the virus and the host cells []. This hypothesis could explain the higher prevalence of COVID-19 in men, although it would fail to explain the rationale for the higher mortality rates, as well as the worse clinical outcomes, for elderly patients.

Additional studies would, therefore, be needed to understand whether testosterone treatment might be beneficial or deleterious for the clinical course of the disease. However, independently of whether testosterone is a friend or foe for COVID-19, it should be acknowledged that the testis is a target for SARS-CoV-2 and the possibility for long-lasting consequences on the endocrine function exists, even for recovered patients.

COVID-19 and the endothelium

Solid evidence accumulated in the last decades support the notion that erectile function is an excellent surrogate marker of systemic health in general, and vascular performance in particular [], sharing plenty of risk factors with cardiovascular disease. This is described by the equation ED = ED (endothelial dysfunction equals erectile dysfunction, and vice versa) []. Vascular integrity is necessary for erectile function [], and vascular damage associated with COVID-19 is likely to affect the fragile vascular bed of the penis, resulting in impaired erectile function [, ]. COVID-19 features a state of hyperinflammation promoted by TNF-α, IL-6 and IL-1β []; the same inflammatory cytokines have been associated with clinical progression of sexual dysfunction []. It is worth noticing that the pro-inflammatory cytokines are also closely tied to testosterone levels: as previously stated, hypogonadal patients have higher concentrations of TNF-α, IL-6 and IL-1β as a result of impaired suppression. This ultimately worsens the endothelial dysfunction, further impairing erectile function. However, whether testosterone replacement therapy (TRT) would improve endothelial function is still debated, while largely beneficial in the treatment of hypogonadal men, TRT has known harmful effects if inappropriately prescribed [], and a meta-analysis study did not find any conclusive evidence of a potentially therapeutic effect of testosterone administration, neither acute nor chronic, on endothelial function []. While erection is—of course—a trivial matter for patients in Intensive Care Units (ICUs), there is reason to suspect that impaired vascular function might persist in COVID-19 survivors and even become a public health issue in the next few months. Moreover, given that erectile function is a predictor of heart disease [, ], investigating whether COVID-19 patients develop ED might also be a good surrogate marker of general cardiovascular function, improving patient care and quality of life.

A COVID eclipse of the heart: potential for cardiovascular burden

Besides the effects on endothelium, SARS-CoV-2 infection can also dramatically affect the heart and exacerbate underlying cardiovascular conditions. Reports of myocarditis in COVID-19 patients have piled up in the last months []; similarly, arrhythmias and acute cardiovascular events have been described in other coronavirus and influenza epidemics [] and are likely to be expected for SARS-CoV-2 as well []. COVID-19 survivors are, therefore, more likely to develop severe cardiovascular consequences. However, treatment is not exempt from possible side effects, among which sexual dysfunctions are remarkably common. Drugs such as β-blockers and antihypertensive agents, routinely used in COVID-19 patients, have the potential to impair sexual function []; therefore, both the cardiovascular consequences and their treatment might ease progression from subclinical to a clinically overt ED [, ].

It is also worth mentioning that several cardiovascular risk factors involved in sexual dysfunctions, such as smoking [], diabetes [] and hyperhomocysteinemia [], are also possible predictors of worse outcomes in COVID-19 patients.

Additionally, as stated in the III Princeton Consensus Panel [], sexual activity should be delayed until the cardiac condition has been stabilized in high-risk patients. Such patients include those with uncontrolled hypertension, recent myocardial infarction or high-risk arrhythmia, which are all conditions closely associated with COVID-19 [].

Reproductive health and COVID-19

Another reason for worry lies in the reported testicular damage from COVID-19 infection. In fact, ACE2 is highly expressed in the testis, suggesting the possibility of testicular infection since the early stage of the disease []. Being expressed in both Sertoli and Leydig cells [, ], ACE2 plays key roles in spermatogenesis and in the regulation of steroidogenesis. Due to the involvement of Sertoli cells, reproductive function might similarly be affected. Additionally, ACE2 is also expressed by spermatogonia, therefore, increasing the risk of SARS-CoV-2 presence in seminal fluid [, ].

Studies investigating the presence of SARS-CoV-2 in seminal fluid have, for the largest part, found no evidence of the virus []. However, as other studies have shown different results [], the topic of reproductive health is still largely debated. In post-mortem examinations, seminiferous tubular injury was reported despite no evidence of the virus in the testis []. Identification of SARS-CoV-2 in semen is of the utmost importance, as sperm cryopreservation is an undelayable necessity for many men, such as those who are about to start gonadotoxic treatments []. In Italy, cryopreservation procedures for oncological patients have continued during the COVID-19 pandemic, using utmost care to limit the risk of transmission; for non-oncological patients, the prospects of biological parenthood could be compromised as a consequence of delaying diagnostic semen analysis and sperm banking []. At the beginning of the pandemic, discontinuation of reproductive care except was recommended by international societies for reproductive medicine, with only the most urgent cases allowed; as containment and safety strategies have mitigated the spread of the disease, several centers for assisted reproductive technology have resumed their activity, although with very precise rules for operators [, ].

Further studies should, therefore, be designed with the aim to clarify this point, above all among “COVID-19 asymptomatic” men requiring assisted reproductive technology (ART).

The psychological burden of COVID-19

Increased rates of post-traumatic stress disorder (PTSD), depression and anxiety are expected in the general population, and even more in COVID-19 survivors, following the pandemic []. A parallel can be drawn between the psychological consequences of COVID-19 and those coming from similar disasters, such as the 9/11 attacks [] or earthquakes [], and similar short- and long-term treatment strategies are, therefore, needed to provide adequate care. Confinement and the illness in itself are both causes of stress; while only a minority of individuals might be more vulnerable to psychological trauma, there is no doubt that most people would experience some degree of emotional distress following isolation, social distancing, loss of relatives and friends, difficulties in securing medications, as well as the obvious economic consequences of lockdown. Sexual activity is closely associated with mental and psychological health; it is, therefore, unsurprising that sexual desire and frequency have declined in both genders during this pandemic [, ]. There is, therefore, reason to suspect that psychological suffering might exacerbate pre-existing subclinical sexual dysfunctions []. Additionally, the potential for SARS-CoV-2 transmission by kissing might lead to increased distress in the couple [], with the resulting negative effects on sexual health and on couple dynamics. Additionally, the hypogonadal state reported in COVID-19 could lead to a significant worsening in sexual desire and mood [, ].

Pulmonary fibrosis and the effects of hypoxia

It has been suggested, with on the basis of interesting evidence, that there could be substantial fibrotic consequences following SARS-CoV-2 infection [, ]. Indeed, pulmonary fibrosis is a well-acknowledged consequence of acute respiratory distress syndrome (ARDS), with further evidence coming from survivors of the 2003 SARS outbreak (caused by the SARS-CoV) [, ]. Pulmonary fibrosis impairs the physiologic lung mechanisms, reducing the pulmonary gas exchange and, therefore, impairing oxygen saturation [, ]; functional disability has been proven in ARDS patients several years after the acute phase of the disease []. There is currently no evidence concerning the possible long-term impairment of lung function following SARS-CoV-2 infection; however, considering the scale of the current pandemic and the similarities between SARS-CoV and SARS-CoV-2 [], there is sufficient reason to suspect a high rate of fibrotic lung function abnormalities in COVID-19 survivors. In such patients, the impaired oxygen saturation could impair erectile function; some evidence in support comes from animal models [, ] as well as from clinical reports [, ]. From a pathophysiological standpoint, this is hardly surprising, as oxygen is one of the substrates required for the synthesis of nitric oxide (NO) by the enzyme NO synthase, whose activity is severely blunted in hypoxia [].

Phosphodiesterase-5 inhibitors in COVID-19

Phosphodiesterase-5 (PDE-5) belongs to the PDE superfamily of enzymes, the last step of the NO/cGMP/PDE pathway and is one of the key elements in drug treatment of ED. NO activates guanylate cyclase in responsive cells, such as endothelial cells, resulting in increased concentrations of the second messenger cGMP (cyclic guanosine monophosphate), which in turn induces relaxation of smooth muscle. PDE acts downstream and reduces effects of cGMP by catalyzing its degradation: PDE inhibitors prevent degradation of cGMP, resulting in prolonged or enhanced action [].

PDE-5 is highly expressed in vascular smooth muscle cells [], and, at high concentrations, in those of the penile corpora cavernosa []; therefore, thanks to their action and due to their high affinity for the specific type 5 isoform [], PDE-5 inhibitors have been approved for their use in treatment of ED since 1998. However, a growing body of evidence has also proven their usefulness as therapeutic agents in different conditions due to their anti-inflammatory and antioxidant actions, as reported in diabetes [], hypertension and chronic kidney disease []. Sildenafil, the first PDE-5 inhibitor approved for the treatment of ED following its serendipitous discovery [], has also been investigated as a treatment for COVID-19 patients; indeed, Sildenafil improves pulmonary hemodynamics, as shown in idiopathic pulmonary fibrosis [], by reducing vascular resistance and remodeling in the pulmonary circulation []. Additionally, by inhibiting neointimal formation and platelet aggregation, sildenafil also might prove beneficial in regard to the risk of vascular injury and thrombotic complications in COVID-19 patients []. Evidence from new trials will prove fundamental to assess the clinical benefits of PDE-5 inhibition on the overall burden of COVID-19 [].

Conclusions

In conclusion, there is quite enough reason to suspect that male sexual and reproductive health could be affected in the survivors, by the sequelae of the COVID-19, both in the short and long terms (Fig. 1). Erectile function, as a surrogate marker of cardiovascular/pulmonary health, could also become extremely valuable as a quick and inexpensive first-line assessment of the pulmonary and cardiovascular complications for COVID-19 survivors. In this regard, evidence coming from diagnostic procedures, such as penile color-doppler ultrasound [] and hypothalamic-pituitary–testicular axis evaluation [], will be necessary to assess the extent to which COVID-19 has been able to impair erectile, and finally vascular, function, the former being an efficient predictor of complete restitutio ad integrum. Additionally, tailored psychological interventions would be necessary to adequately support patients who develop sexual dysfunction consequently to the containment measures.

An external file that holds a picture, illustration, etc. Object name is 40618_2020_1350_Fig1_HTML.jpg

Graphical overview of the involvement of SARS-CoV-2 in the pathogenesis of erectile dysfunction

Acknowledgements

Open access funding provided by Universitá degli Studi di Roma Tor Vergata within the CRUI-CARE Agreement. The authors are in debt with Dr. Tarek Hassan (Pfizer, New York, NY) for discussion on the role of PDE5 and of PDE5i in COVID-19 management. This paper is partially supported by the PRIN Grant #2017S9KTNE_002.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This manuscript is a review of the literature and does not contain original research either on animal or on human subjects.

Research involving human participants and/or animals

This article does not contain any studies involving animals and/or human participants performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Celery Benefits for Men: Fact or Fiction?

Does Celery Have Benefits for Men?

Written by Daniel Preiato, RD, CSCS on November 13, 2020 — Medically reviewed by Jillian Kubala, MS, RD

This article is a repost which originally appeared on Healthline

Edited for content

Consuming celery and its juice has become increasingly popular in recent years due to its purported health benefits, one of them being improved sexual health for men.

Despite the lofty claims of various media outlets, data on the specific health benefits of consuming celery remains limited.

Nevertheless, some may wonder whether consuming celery has benefits for men.

This article details the potential effects of eating celery on several markers of men’s sexual health.

Myths vs. science

Various myths are circulating regarding celery’s purported benefits. Here’s what science has to say about some of the most common ones.

Does celery increase androsterone levels?

Androsterone is a weak steroid metabolite of the sex hormone testosterone, which naturally occurs in both sexes, although to a greater extent in men than in women (1).

This hormone, in conjunction with others, contributes to male characteristics like body hair and is found in human sweat (1).

Several media sources claim that celery is packed with androsterone and thus can lead to increased testosterone levels and sex drive in men.

Although some studies show that celery contains androsterone, there’s no evidence that eating celery or drinking its juice increases androsterone levels or improves sex drive in men.

Could this veggie be considered an aphrodisiac?

Aphrodisiacs are foods or drugs that stimulate sexual desire.

Pheromones are chemical hormones that function outside of the body and play a role in various phenomena, one of which is sexual attraction.

Androsterone is considered a pheromone, as it’s found in small amounts in human sweat.

Some claim that celery can serve as an aphrodisiac due to its pheromonic properties when eaten, though little to no research has been conducted on this subject. Therefore, more data is needed to confirm this potential effect.

SummaryWhile several media sources claim that celery can boost androsterone levels and serve as an aphrodisiac, limited to no data supports this theory, and more research is necessary.

Other potential benefits

Though data on the specific effects of celery intake on male sexual health is limited, celery may provide some other potential benefits.

May promote fertility

Celery is high in vitamin C and phytonutrients, which are antioxidant plant compounds that have been shown to have anti-inflammatory properties.

While antioxidants can help reduce disease risk, they may also promote male sexual health.

More specifically, select human studies suggest that a high antioxidant intake can help improve sperm count and motility, both vital factors in male fertility.

One animal study observed an increase in sperm production when supplementing with celery leaf extract.

However, extracts are much more concentrated and don’t necessarily compare to eating celery or drinking its juice.

Moreover, additional human research is needed to determine the specific benefits of celery on male fertility.

May help lower blood pressure

Celery and its juice may also aid blood pressure control.

This is likely due to the naturally occurring nitrates found in celery, which can promote heart health and help lower blood pressure.

What’s more, high blood pressure has been repeatedly linked to erectile dysfunction in men.

That said, regularly consuming a wide variety of fruits and vegetables, including celery, may improve symptoms of erectile dysfunction, though more data is needed on this subject to establish its specific benefits.

Lastly, depending on the degree of high blood pressure, prescription drugs may also be required. As such, it’s best to consult your healthcare provider.

High in vitamin K

Celery is a rich source of vitamin K, with 1 cup (124 grams) providing around 30% of the daily requirement for men.

Vitamin K is an important nutrient for blood clotting and bone health.

While the bacteria in your gut produce some vitamin K, dietary sources are required to help meet the daily requirement, which is around 120 mcg for men.

Regularly eating celery is a great way to help maintain vitamin K levels, in turn promoting bone health and efficient blood clotting.

SummaryThough data on the effect of celery on men’s health is limited, it may provide a few potential benefits, including promoting fertility, regulating blood pressure, and providing a rich source of vitamin K.

The bottom line

Consuming celery and its juice is an emerging health trend that claims to offer various benefits related to men’s sexual health, though data is lacking.

While it may marginally contribute to fertility, as well as help regulate blood pressure, more data is needed to determine its specific effects on other factors surrounding male sexual health.

That said, including celery and its juice as a part of an overall balanced diet is an excellent way to improve your nutritional intake and reap the benefits of the antioxidants it provides.

 

Medications that cause erectile dysfunction

What medications may cause erectile dysfunction?

Several factors can cause or contribute to erectile dysfunction. One example is the medications a person takes. Medicines that affect sex drive, blood flow, and sexual organ function may increase the incidence of erectile dysfunction.

Medically reviewed by Matt Coward, MD, FACS — Written by Rachel Nall, MSN, CRNA on November 11, 2020

This article is a repost which originally appeared on MEDICALNEWSTODAY

Edited for content

Several factors can cause or contribute to erectile dysfunction. One example is the medications a person takes. Medicines that affect sex drive, blood flow, and sexual organ function may increase the incidence of erectile dysfunction.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection. It is a common condition that affects males of all ages and varying levels of health and fitness.

This article lists some medications that may cause or contribute to ED, and outlines some treatment options. Finally, we offer some tips to help prevent ED.

Medications that may cause ED
Certain medications may contribute to ED, although they are not usually the sole cause of the condition.

A person who suspects their ED may be due to a particular medication should talk to their doctor. Where possible, a healthcare professional may recommend changing the dosage or switching medicines.

A person should not stop taking their medications unless their doctor tells them to do so.

Some medications that may contribute to ED are below.

Anti-hypertensives

Anti-hypertensives are prescription medications to help lower blood pressure. They may contribute to ED, though doctors have not yet established why this is the case.

Examples include:

  • beta-blockers, such as metoprolol and atenolol
  • clonidine
  • spironolactone
  • some diuretics, such as hydrochlorothiazide and furosemide

Immunosuppressants

Immunosuppressants reduce the activity of the immune system. A person may take them to help control an autoimmune condition or prevent organ rejection following an organ transplant procedure.

One potential side effect of immunosuppressants is impaired sexual function.

Examples include:

  • sirolimus
  • everolimus
  • tacrolimus
  • cyclosporine

Anti-androgens

Androgens are hormones associated with male characteristics. Anti-androgens block some aspect of these hormones. Doctors may prescribe them for several conditions, such as heartburn or prostate cancer.

Examples of anti-androgens include:

  • ketoconazole
  • flutamide
  • bicalutamide
  • nilutamide
  • enzalutamide

GnRH agonists

Gonadotropin-releasing hormone (GnRH) agonists are a class of medications that doctors sometimes prescribe to treat prostate cancer. They may reduce sexual desire in men.

Examples include:

  • leuprolide (Lupron)
  • goserelin (Zoladex)

Corticosteroids

Corticosteroids are drugs that mimic the effects of certain hormones inside the body. People typically take them to help reduce inflammation.

These drugs can also reduce testosterone levels. This may lead to decreased sexual desire and sexual function in some men.

Examples of corticosteroids include:

  • prednisone
  • prednisolone
  • hydrocortisone

Antidepressants

Antidepressants are medications that doctors may prescribe to treat or prevent the recurrence of clinical depression.

Some antidepressants may inhibit sexual desire, which may affect sexual performance. Others may also delay ejaculation.

Examples of antidepressants that may cause ED include:

  • selective serotonin reuptake inhibitors (Lexapro, Prozac)
  • noradrenaline reuptake inhibitors (Wellbutrin, Zyban)
  • tricyclic antidepressants (Pamelor)

Antipsychotics

Antipsychotics are drugs primarily prescribed for the treatment of psychosis. They may inhibit sexual desire, which may then affect sexual performance.

Examples include:

  • aripiprazole (Ability)
  • olanzapine (Zyprexa)
  • risperidone (Risperdal)

Anti-epileptics

Anti-epileptics are medications that doctors prescribe to help prevent epileptic seizures. They may affect a man’s ability to orgasm.

Examples include:

  • gabapentin (Neurontin)
  • topiramate (Topamax)

Recreational drugs

Aside from medications, some recreational drugs can also affect sexual arousal and performance. Examples include:

  • alcohol
  • hallucinogens
  • narcotics, such as heroin
  • stimulants, such as cocaine and methamphetamines

Drugs to treat opioid addiction may also lead to erectile dysfunction. These drugs include methadone and buprenorphine.

What is ED?

ED is the medical term for when a person has difficulty achieving or maintaining an erection. While this may occur periodically for all males, those with ED experience more frequent and routine episodes.

The ability to achieve and maintain an erection is dependant on several factors, including:

  • sexual arousal
  • sufficient blood flow to the penis
  • nerve sensation

An issue with any of the above factors may lead to ED.

Treatments for ED

A doctor may recommend treatments that can enhance sexual performance while allowing a person to continue taking potentially life-saving or life-extending medications. Some examples are below.

Self-care

Often, ED treatments begin with making changes to a person’s routine. These include:

  • adopting healthful eating habits
  • increasing daily exercise
  • maintaining a healthful weight
  • limiting or avoiding alcohol
  • quitting smoking
  • avoiding using recreational drugs
  • sleeping well

Males who experience mental health issues, such as stress, anxiety, or depression, may also benefit from seeing a mental health professional. These conditions can negatively impact sexual desire and sexual function. As a result, successful treatment may help manage ED.

Medications

A doctor may prescribe one of the following medications to help treat ED.

Phosphodiesterase type-5 inhibitors

Phosphodiesterase type-5 (PDE 5) inhibitors are medications that relax and widen the blood vessels to promote blood flow. The American Urological Association (AUA) recommend that males take PDE 5 inhibitors 1–2 hours before having sex.

Examples of PDE 5 inhibitors include:

  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Stendra)
  • sildenafil citrate (Viagra)

PDE 5 inhibitors are not suitable for people taking nitrates.

Injections

A vasodilator is a medication that helps widen the blood vessels, increasing blood flow.

One potential ED treatment involves injecting the vasodilator directly into the penis or urethra.

Testosterone therapy

According to the AUA, the vast majority of ED cases are due to reduced blood flow to the penis. They add that low testosterone levels may affect a person’s sex drive, but are rarely the cause of ED.

If low testosterone levels contribute to ED, a doctor may consider testosterone therapy (TT). This technique involves regularly administering testosterone in one of the following forms:

  • an injectable medication
  • a gel
  • a patch applied to the skin.

However, the AUA state that TT does not improve erections in males with normal testosterone levels or in those with low testosterone levels who experience ED as their only symptom.

Devices

A vacuum erection device (VED) consists of a plastic tube and a pump. The plastic tube fits over the penis, forming a seal against the body’s skin. Using the pump creates a vacuum around the penis, which causes an erection.

Once the penis is erect, the person slips an elastic ring onto the base of the penis. This retains the blood inside the penis for up to 30 minutes.

According to the AUA, around 75% of males who receive proper training on using a VED can achieve an erection when using these devices.

Surgical treatments

If lifestyle measures and medical treatments are ineffective, doctors may recommend surgical options for ED. These are outlined below.

Penile implant procedure

The main surgical option for ED is inserting a penile implant. This device sits permanently inside the penis, making it rigid enough for a person to have sex.

There are two types of penile implant:

  • Semi-rigid implant: Bendable silicone rods that a person can bend downward for urinating or upward for sex.
  • Inflatable implant: Fluid-filled cylinders attached to a rod inside the scrotum. Using the pump forces fluid into the cylinders, causing the penis to enlarge and stiffen.

Vascular surgery

Vascular surgery for ED helps improve blood flow to the penis. Doctors usually reserve this procedure for younger males with good vascular with ED due to pelvic trauma.

Reducing The Risk Of Erectile Dysfunction With Nutrition

Reducing The Risk Of Erectile Dysfunction With Nutrition

Posted on Jun 01, 2020, 4 p.m.

This article is a repost which originally appeared on WORLDHEALTH.NET

Edited for content

At some point in their lives most men will struggle with penile health issues, when it comes to this these issues involve more than erections, ejaculations, and reproduction as poor penile health can be a sign of an underlying health condition.

Additionally issues that affect the penis can also impact other areas of your life including emotionally and socially. Bottom line is that routine maintenance in this area can also help to ensure optimum performance which includes managing stress, getting enough sleep, being physically active, and following a healthy well balanced diet. According to research from Harvard University men should masturbate (routine maintenance) 21 times a month to reduce the odds of prostate cancer by 33%.

Simply masturbating 21+ times a month is not enough to guarantee to avoid prostate cancer, but added to a healthy diet full of organic produce, getting enough sleep, managing stress, being active and exercising, this will go a long way. Ian Kerner, PhD,  recommends a plant based diet and incorporating plenty of fish rich in Omega-3 fatty acids, as well as “consuming red foods such as tomatoes that are rich in lycopene, as well as soy products that contain isoflavones, along with getting regular physicals that include a prostate exam, and plenty of exercise.

Diet and nutrition play a bigger part in health than most people understand, and this includes penile health. Certain types of food have been shown to affect penis health, for example studies have shown that diets rich in flavonoids, which occur naturally in fruits, vegetables and whole grains, are associated with a reduced risk of erectile dysfunction in men under the age of 70.

There are many things that can affect an erection like poor health, smoking, and certain medications. Following a sub par diet, how much you eat, and how often you eat can affect your mood, energy levels, blood flow, and hormones which are all very important to your sex life.

It stands to reason that if certain foods can boost your erection, keep sperm healthy, and boost testosterone levels then eating habits exist that can also kill your libido. Unhealthy fats and added sugars can exacerbate erectile issues, and lower testosterone levels. Alcohol is a depressant which can numb the feeling of sexual stimulation, alter the blood flow in/out of the penis, and decrease testosterone levels sapping libido, energy, and moods.

Achieving and maintaining an erection requires good blood flow and plenty of nitric oxide. Flavonoids have been shown to improve cardiovascular health by helping to increase blood flow and the concentration of nitric oxide in the blood. Dark chocolate is rich in flavonoids, other choices include tea, citrus fruits, berries, apples, legumes, onions, tomatoes, broccoli, tea, grapes, celery, red peppers, ginger, red cabbage, asparagus, and leafy greens.

Pistachios are good for more than a snack, a study published in the International Journal of Impotence Research suggests that consuming these nuts for several weeks improved several parameters of ED including improved International Index of Erectile function scores, improved cholesterol levels and improved blood pressure with no notable side effects being observed.

Watermelon may help to improve sexual function as a study from Texas A&M University found connections between ED and watermelon, suggesting that citrulline found in watermelon helped to relax blood vessels and improved blood flow in a similar manner as to medications for ED.

Bananas are a great source of potassium which is great for keeping the heart and circulation strong. Potassium also keeps blood pressure in check by stabilizing sodium levels. Bananas are also a rich source of vitamin B which helps to increase energy levels, and combat stress that can lead to erectile dysfunction.

Salmon is a great source of omega-3 fatty acids which can help to enhance blood flow and enhance erectile function by helping to relax your arteries easing the way for blood to flow to the entire body without exception, including your penis. Salmon also contains vitamin D, selenium and magnesium which are all required to support testosterone levels and healthy sperm.

Anthocyanins are great for cardiovascular health, cherries are loaded with anthocyanins, which are flavonoids, that help to protect your artery walls and help prevent fatty plaques from forming in the arteries ensuring good blood flow and circulation.

Soluble fiber such as that in oatmeal has been shown to be great for satiety, fighting inflammation, to lower cholesterol levels and helps to keep your blood vessels smooth, healthy and stretchy, which also can apply to penis health.

Cruciferous vegetables such as broccoli can help to combat cancer, and the high vitamin C content helps to boost blood circulation and it has been linked to an improved libido. Cruciferous veggies such as bok choy, cabbage, and Brussels sprouts also contain glucobrassicins which help to clear the body of excess oestrogen which may help to boost your sex drive.

The antioxidant phytochemical resveratrol helps to open arteries by enhancing the production of nitric oxide, production of nitric oxide allows blood vessels to expand, and increases blood flow. Resveratrol works by expanding the tiny and main arteries in the penis much like medications for ED. It also helps to block enzymes that trigger the body to push away testosterone, which will help maintain high levels of the hormone and strong erections that should last well beyond foreplay.

After reaching the age of 30 testosterone levels begin to decrease, fortunately there are simple diet fixes that may help you, and because your brain, heart and penis are all intimately connected this is also good for your overall health and well being. Aging also affects your penis, as a result many men experience erectile difficulties, if you are one of them please consult with your physician as it can be an indication of an underlying condition that shouldn’t be ignored. Your physician can work with you to help determine the cause and work towards a solution, often lifestyle changes can help.

Male Sexual Worries: Trends in the Post-Viagra Age

Male Sexual Worries: Trends in the Post-Viagra Age

This article is a repost which originally appeared on SciTechDaily

Edited for content

Trends in reasons for visiting a the San Raffaele sexual health clinic. Credit: This diagram appears with the permission of the authors and the International Journal of Impotence Research. The EAU thanks the authors, and the journal for their cooperation.

Scientists report a change in why men seek help for sexual problems, with fewer men complaining about impotence (erectile dysfunction) and premature ejaculation, and more men, especially younger men, complaining about low sexual desire and curvature of the penis (Peyronie’s disease).

Presenting the work at the European Association of Urology (virtual) Congress, after recent acceptance for publication, research leader Dr. Paolo Capogrosso (San Raffaele Hospital, Milan, Italy) said:

“Over a 10 year period we have seen a real change in what concerns men when they attend sexual health clinics. This is probably driven by greater openness, and men now accepting that many sexual problems can be treated, rather than being something they don’t want to talk about.”

The success of erectile dysfunction treatments such as Viagra and Cialis, and the availability of new treatments, means that men facing sexual problems have now have treatments for sexual problems which weren’t available a generation ago. Now researchers at San Raffaele Hospital in Milan have studied why men come to sexual health clinics, and how this has changed over a 10-year period.

In what is believed to be the first research of its kind, the scientists questioned 3244 male visitors to the San Raffaele Hospital Sexual Health Clinic in Milan over a 10 year period (2009 to 2019), and classified the main reason for the visit. They found that the number of patients visiting with erectile dysfunction problems increased from 2009 to 2013, then started to decrease.

There were comparatively few patients complaining of low sex drive or Peyronie’s disease in 2009, but complaints about both of these conditions grow from 2009 to the end of the study. In 2019 men were around 30% more likely to report Peyronie’s disease than in 2009, and around 32% more likely to report low sexual desire.

The amount of men complaining of premature ejaculation dropped by around 6% over the 10-year period. The average age of first attendance at the clinical also dropped, from a mean of 61 to 53 years.

“Erectile dysfunction is still the main reason for attending the clinic, but this number is dropping, whereas around 35% of men attending the clinic now complain of Peyronie’s disease, and that number has shown steady growth,” said Paolo Capogrosso. “Our patients are also getting younger, which may reflect a generational change in attitude to sexual problems.”

Dr. Capogrosso continued “We need to be clear about what these figures mean. They do not indicate any change in the prevalence of these conditions, what they show is why men came to the clinic. In other words, it shows what they are concerned about. The changes probably also reflect the availability of treatments; as treatments for sexual conditions have become available over the last few years, men are less likely to suffer in silence.”

These are results from a single centre, so they need to be confirmed by more inclusive studies. “Nevertheless there seems to be a growing awareness of conditions such as Peyronie’s disease, with articles appearing in the popular press*. In addition, we know that the awareness of this condition is increasing in the USA and elsewhere, so this may be a general trend,**” said Dr. Capogrosso.

Commenting, Dr Mikkel Fode (Associate Professor of Urology at University of Copenhagen), said:

“Although these data are somewhat preliminary as they stem from single institution they are interesting because they allow us to formulate several hypotheses. For example the drop in men presenting with erectile dysfunction may mean that family physicians are becoming more comfortable addressing this issue and that the patients are never referred to specialized centers. Likewise, the simultaneous drop in age at presentation and increase in Peyronie’s disease and low sex drive could indicate that both men and their partners are becoming more mindful to optimizing their sex lives. I will be very interesting to see if these trends are also present in other centers around the world.”

Dr. Fode was not involved in this work, this is an independent comment.

References:

* “Trends in reported male sexual dysfunction over the past decade: an evolving landscape” by Edoardo Pozzi, Paolo Capogrosso, Luca Boeri, Walter Cazzaniga, Rayan Matloob, Eugenio Ventimiglia, Davide Oreggia, Nicolò Schifano, Luigi Candela, Costantino Abbate, Francesco Montorsi and Andrea Salonia, 1 July 2020, International Journal of Impotence Research.

** “The Prevalence of Peyronie’s Disease in the United States: A Population-Based Study” by Mark Stuntz, Anna Perlaky, Franka des Vignes, Tassos Kyriakides and Dan Glass, 23 February 2016, PLOS ONE.
DOI: 10.1371/journal.pone.0150157
PMCID: PMC4764365